There has been an alarming rise in new HIV infections among young gay men (ages 13 to 24). In fact, from 2008 to 2010, there was a 22 percent increase in new infections among young men who have sex with men (MSM) and, from 2006 to 2009, a 48 percent increase among young black men.

So, why we are seeing this spike?

For decades, the country has approached the HIV/AIDS epidemic focused on individual behavioral risk. But, research shows that is only one part of the equation.

It may be surprising that a more effective approach would involve focusing on improving the overall health of LGBTQ individuals by developing supportive and respectful policies that reduce stigma, discrimination and bullying.

This approach would reduce the risk for HIV/AIDS and for depression, violence, suicide, substance abuse and other negative outcomes.

While discrimination against LGBTQ people is diminishing in many areas -- such as marriage equality, military service, housing fairness and employment laws and practices -- the impact of marginalization persists.

And, youth are more likely than adults to be the victims of antigay prejudice or violence, and may suffer greater consequences -- childhood or adolescent adversity has long been associated with adverse health outcomes later in life. In fact, a number of studies have demonstrated a link between stigma experienced by LGB youth and higher rates of health problems including depression and suicidal ideation, substance abuse, and risky sexual behaviors.

Quite simply, to prevent and reduce HIV/AIDS, we must think beyond "it gets better" for teen and young adult MSM toward how it could be better now. We need a policy agenda that prioritizes fostering respect and support -- with special attention in early adolescence.

To start, federal, state and local governments -- and families, faith based organizations and communities -- must play more proactive roles in at least four strategic areas:

Stopping Bullying: There is a national movement against bullying, but LGBTQ teens are bullied at higher rates so additional strategies must be employed -- such as supporting Gay/Straight Alliance clubs that help increase tolerance and provide a safety net for students during the coming out process, educate teachers and peers to reduce slurs and work with administrators to prevent harassment and violence.

Community Programs: There are many ways to support LGBTQ youth for risks they may face outside of school -- for instance, access to safe environments like youth centers, cross-generational support and mentoring programs, extracurricular activities and General Education Development programs. Also job training, skills building and housing support programs can help expand economic and housing opportunities while strong mentorship and community and spiritual support programs are all essential and important to maintain throughout the lifespan.

In the Health Care System: LGBTQ teens and youth need regular access to affordable health services that are tolerant and well-informed about LGBTQ concerns. Because LGBTQ youth are aware of stigmatizations, they are often reluctant to disclose their sexual orientation and are less likely to receive appropriate screening. Outreach and services must be made available to youth who do not have regular access to healthcare and/or are disenfranchised from their families and other support systems. This is particularly crucial in light of recent survey data that has shown that many gay men don't have a regular source of care, have not been encouraged to get an HIV test, and are poorly informed about treatment options.

In Families:LGBTQ youth whose families are more supportive have significantly lower rates of depression, substance abuse and suicidal ideation and attempts. It is important for federal, state, local, community and faith-based programs to support families of LBGTQ youth, such as through parenting skills-building, case management services, professional best practices in the justice and healthcare systems, and promotion of positive role models.

If we do a better job of providing a supportive and respectful environment early in life, we could help reduce the risk of HIV/AIDS and assure a higher quality of life for the next generation of LGBTQ Americans.

These policy recommendations and many others are outlined in a new report supported by the M•A•C AIDS Fund.

Jeff Levi is a former deputy director of the White House Office of National AIDS policy under President Clinton and is the current executive director of the Trust for America's Health]]>By Focusing on Health, a Community Goes From 'Little Vietnam' to Vibrant and Thrivingtag:www.huffingtonpost.com,2013:/theblog//3.37899532013-09-03T17:05:33-04:002013-11-03T05:12:01-05:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/The piece was co-authored with Carol Naughton, Senior Vice President, Purpose Built Communities

Effective, affordable health care is essential for improving health, but what happens beyond the doctor's office also has a major impact on how healthy we are. There is increasing understanding of how important it is to combine good medical care with support in daily life.

Where we live, learn, work and play all make a difference -- for better or worse. Nutritious school lunches, affordable healthy foods, safe places to live, convenient places to exercise, clean air and water and a range of other factors contribute to how healthy we are. In fact, where you live can dramatically increase your chance of living a longer, healthier life, in some cases by as much as 13 years.

One of the main factors in helping or hindering someone in becoming healthy is what is known as the built environment, e.g., the infrastructure -- parks, sidewalks, roads, local businesses, etc. -- that surround (or don't) someone. Not only does intentionally building healthier communities lead to improvements in the public's health, but it improves the economy, education and infrastructure. Basically, everything impacts health, and good health can benefit everyone and everything in a community.

To address these systemic, pervasive problems, community groups partnered with one another and local government to focus on health and everything that affects health -- ultimately forming the East Lake Foundation. This new nonprofit served as the quarterback to assure that the revitalization work was accomplished in a coordinated, comprehensive way and at very high standards.

Health was at the center of revitalizing East Lake -- the work focuses on three interconnected strategies:

Bringing the community wellness partners/programs together to create healthy sustainable neighborhoods.

In total, the collective actions of the community created a new wellness center by partnering with the YMCA, intentionally built health into the school day, ensured the entire neighborhood was walkable and bikeable, and worked to attract businesses and markets that could offer fresh, affordable healthy foods.

After the work in East Lake, Purpose Built Communities was created by the founders of the East Lake Foundation to help other civic and business leaders apply the model to create opportunities in other struggling unhealthy neighborhoods.

The Purpose Built Communities Model is a deep dive into a clearly-defined, narrowly-tailored geographic area: a neighborhood. Within that neighborhood, over a 10-year period, distressed low-income rental housing is replaced with high-quality mixed-income housing; a cradle-through-college education pipeline is created to serve the neighborhood; and wellness and health-related facilities and programs are implemented so that everyone in the neighborhood can be healthy, in the fullest sense of the term.

These strategies are executed by many partners under the direction of a newly-created nonprofit organization -- modeled on the East Lake Foundation -- whose sole reason for existence is to make sure that the revitalization model is fully realized at very high standards. The new nonprofit, called a "lead organization," doesn't necessarily deliver programs itself, but serves as the quarterback of the initiative.

The successes in East Lake are expansive and The East Lake neighborhood has come a long way since the days when residents called it "Little Vietnam" because it felt like a war zone. All of the adults in the Villages of East Lake work unless they are elderly or disabled. In 2013, 99 percent of the third through eighth grade students in the neighborhood's Charles R. Drew Charter School passed the state assessment in reading, and 98 percent did so in math. The crime rate in East Lake is also dramatically lower -- now 50 percent of the average crime rate of the city of Atlanta.

Research shows that people are healthier when they live in communities that include high quality mixed-income housing, top-notch education and opportunities for recreation and civic engagement. It is the job of those in the community development arena to marshal existing resources in an effective way to create communities where the healthy choice is the easy choice.

There is no denying that this work is hard and complex, involving multiple players and systems, many of which do not have a track record of working effectively together. Nevertheless, we now have a model to rebuild neighborhoods so that they can serve as a platform that allows families to break the cycle of poverty by improving their health, safety and economic prospects.

As Tom Cousins, the Atlanta-based developer and philanthropist who spearheaded the revitalization of East Lake and then created Purpose Built Communities to replicate that model nationwide says, "There is a solution. It can be done. East Lake proves it. New Orleans and Indianapolis prove it. And if it can be done in these neighborhoods, it can be done anywhere."]]>The Best 97th Birthday Present for the National Parks Service? More Parks.tag:www.huffingtonpost.com,2013:/theblog//3.38306592013-08-29T10:12:28-04:002013-10-29T05:12:01-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/F as in Fat: How Obesity Threatens America's Future.

To improve the health of all children and curb obesity at every age, the report recommended that kids and adults have access to more opportunities to be physically active on a regular basis -- one of the main drivers of obesity is physical inactivity.

For some time, the nation has known that we need to get kids more physically active, yet, according to the National Parks Service, the unmet need for outdoor recreation facilities and parkland acquisition at the state level is $27 billion. It is staggering that the nation has failed to provide millions of children with access to safe places to play and exercise.

One major resource in sustaining and creating parks is the Land and Water Conservation Fund (LWCF), which uses fees paid by oil companies drilling off-shore to protect parks and public lands and create outdoor recreation opportunities across the country. Unfortunately, while hundreds of millions of dollars in oil and gas royalties are paid into the LWCF annually, Congress continually redirects most of the money.

Even with diminish and inconsistent funds, state and local governments in nearly every county in the United States have used LWCF matching grants to build or renovate playgrounds, parks, swimming pools, urban bike paths, soccer fields, baseball fields and other facilities. In fact, LWCF funding has supported more than 41,000 local projects over the last 50 years.

One notable example is Valle de Oro National Wildlife Refuge (VDO), the first urban wildlife refuge in the Southwest, which is located along the Rio Grande in a historically underserved and predominantly Latino community and is within driving distance of over half of New Mexico's population. VDO, supported by LWCF and substantial state and local funds, provides urban Albuquerque residents access to outdoor recreation, educational opportunities and natural areas. "This will change children's lives," said Angela West, a community member.

In short, LWCF plays an important role in protecting some of our country's most valuable public lands, balancing development with conservation of public lands and providing opportunities for families to enjoy places such as Chattahoochee River NRA, Santa Rosa and San Jacinto Mountains National Monument, Rocky Mountain Arsenal National Wildlife Refuge, Mount Rainier National Park, the Appalachian National Scenic Trail and many other areas.

We've seen how successful the LWCF can be with the bare minimum of resources. If fully funded, the LWCF could put a serious dent in the $27 billion unmet need for parks across the nation. That's why TFAH joined many other public health and youth organizations in writing a letter to the First Lady and Department of the Interior Secretary Sally Jewell asking that they publicly support full funding for LWCF as a key component in the fight against childhood obesity.

From our public health standpoint, it's simple. Safe and maintained places to be active and exercise are essential to solving the nation's childhood obesity crisis -- if kids can't go out into their neighborhoods and play, we'll never be able to increase physical activity.

Any policymaker who wants to improve the health of the nation should support full funding for LWCF -- it would make a nice 97th birthday gift for the National Parks Service.]]>Adult Obesity Rates Remain High but Held Steadytag:www.huffingtonpost.com,2013:/theblog//3.37689572013-08-19T10:46:33-04:002013-10-19T05:12:01-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/F as in Fat, a study by TFAH and the Robert Wood Johnson Foundation, has raised awareness about the seriousness of the obesity epidemic. And, after decades of bad news, we're finally seeing signs of progress. Recently, we found that obesity rates remained level in every state except for one in the past year.

In addition to the latest data showing a stable rate for adult obesity, a new report released by the Centers for Disease Control and Prevention (CDC) earlier this month shows 18 states and one U.S. territory experienced a decline in obesity rates among preschool children from low-income families. The report provides state-specific trends in obesity rates among children ages 2 to 4 who are enrolled in federal health and nutrition programs, such as the Special Nutrition Program for Women, Infants, and Children (WIC).

However, even with an apparent stabilization of adult rates and the first signs of decreases in childhood obesity rates, progress is uneven. For instance, in most places where rates of childhood obesity have declined, children living in lower income communities and communities of color are experiencing slower reductions in obesity or no progress at all.

Further, while stable adult rates are important, to really improve health, they have to be reversed -- as rates are incredibly high. Currently, 13 states now have adult obesity rates above 30 percent, 41 states have rates of at least 25 percent, and every state is above 20 percent, according to the report.

To put that in perspective, in 1980, no state was above 15 percent; in 1991, no state was above 20 percent; in 2000, no state was above 25 percent; and, in 2007, only Mississippi was above 30 percent.

Our analysis also found two alarming trends. Obesity rates vary greatly by age. Obesity rates for baby boomers (45-to 64-year-olds)** have reached 40 percent in two states (Alabama and Louisiana) and are 30 percent or higher in 41 states. By comparison, obesity rates for seniors (65+ years old) exceed 30 percent in only one state (Louisiana). Obesity rates for young adults (18-to 25-year-olds) are below 28 percent in every state.

This is a massive rise in adults and kids. So even if average BMI begins to go down, the health care consequences/costs may not if morbid obesity continues to rise. If you think about how much Medicare currently spends on obesity-related illnesses, you can imagine that we're about to see that balloon as the boomers are aging into obesity-related illnesses and Medicare.

And, rates of "extreme" obesity have grown dramatically over the last few decades. Rates of adult Americans with a body mass index (BMI) of 40 or higher have grown in the past 30 years from 1.4 percent to 6.3 percent -- a 350 percent increase. Among children and teens (2-to 19-year-olds), more than 5.1 percent of males and 4.7 percent of females are now severely obese.

Still, perhaps for the first time ever, there's some good news in the obesity epidemic. Real and lasting progress is being made in the nation's effort to turn back the obesity epidemic. We know what is working to make that progress.

Our success among children has taught our nation how to prevent obesity: changing public policies, community environments, and industry practices in ways that support and promote healthy eating and physical activity. When schools, parents, policymakers and industry leaders get together, they can make the healthy choice the easy choice and improve lives.

Our challenge is to ensure that everyone shares in the benefits of what we are learning and the progress we are making. We must build a movement around a truly comprehensive approach to making our nation healthier, citizen by citizen, town by town, state by state.

In order to decrease obesity and related costs, we must ensure that policies at every level support healthy choices, and we must focus investments on prevention, including supporting the Prevention and Public Health Fund and Community Transformation Grants. In addition, all food in schools must be healthy; kids and adults should have access to more opportunities to be physically active on a regular basis; restaurants should post calorie information on menus; food and beverage companies should market only their healthiest products to children; the country should invest more in preventing disease to save money on treating it; America's transportation plans should encourage walking and biking; and everyone should be able to purchase healthy, affordable foods close to home.

** (45- to 64-year-olds includes most baby boomers, who range from 49- to 67-year-olds.)

For more healthy living health news, click here.]]>Help People Follow the Doctor's Orders: Insurers Must Expand Coverage of Preventiontag:www.huffingtonpost.com,2013:/theblog//3.30912222013-04-17T15:32:28-04:002013-06-17T05:12:01-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
Traditionally, private and public insurers have focused on covering care after we've already sick or hurt. But the research shows that increasing preventive "well care" and providing the support to help make healthier choices easier in our daily lives gives us a chance to follow doctor's orders and actually improves health. And, this approach translates into less need to return to the doctor and should bring down health care costs.

For too long, our system has been set up to focus on "sick care," instead of helping us all stay healthier in the first place. This needs to change and, thankfully, it has begun to.

A portion of the Affordable Care Act (ACA) actually calls for attention to prevention, requiring increased coverage of "well care" and prevention at the doctor's office and providing new opportunities for insurers to expand coverage for proven community-based programs.

In fact, the ACA requires private and self-insurers to cover, in new plans, the most health- and cost-effective, strategic prevention screenings, counseling services and immunizations with no co-payments -- as well as annual well visits under Medicare and provides incentives for state Medicaid programs to cover more preventive services. This will save lives and money: according to Health Affairs, a greater use of 20 proven clinical preventive services would save more than two million lives annually and could result in savings of $3.7 billion annually.

Now, we need to make sure that Americans know about and are taking advantage of these benefits because they are currently underused. Close to half of the U.S. population does not access the commonly recommended clinical preventive services. In addition, all insurers, including every Medicaid program, should expand coverage to include these services.

To go along with this increased preventive care, we now also need to expand coverage of proven, community-based programs that make it easier for Americans to make healthier choices in their daily lives.

Unfortunately, many efforts to cover these programs have been constrained by the outdated and faulty "sick care" model that focuses on individual beneficiaries and fee-for-services. However, we're at a turning point -- the ACA is beginning to open up a new world, with increased attention and incentives for improving health and controlling costs paired with greater understanding that achieving these goals means providing support to Americans outside the clinical setting in neighborhoods, schools and workplaces.

For instance, the National Diabetes Prevention Program (DPP) is showing big payoffs for improving health and bringing down costs. The DPP is a 16-week lifestyle improvement program for individuals at high-risk for diabetes. This program engages individuals in group education with a trained lifestyle coach, focusing on improved eating habits, increased physical activity and other behavior modifications. UnitedHealth Group began partnering with the YMCA in 2010 to replicate this program, working with pharmacist-led education and behavioral intervention initiatives within the pharmacy setting at Walgreens. Some states help support DPP via public-private partnerships with Medicaid. Participants in the Y's program lost an average of 4.8 percent of their body weight, while hundreds of individuals lost an average of 7 percent of body weight. Now, thanks to new funding from the Prevention and Public Health Fund, the Centers for Disease Control and Prevention (CDC) is helping to bring this program to an even larger scale.

In addition, a number of public and private insurers are starting to cover evidence-based prevention programs in communities. For instance, Blue Cross and Blue Shield (BCBS) companies are using their resources, including hundreds of employee volunteers, to promote wellness and the prevention of disease through programs tailored to meet the needs of rural, urban and targeted ethnic and cultural communities. Also, Kaiser Permanente funds community health initiatives (CHI) that take a preventive approach to health care through targeted grantmaking and convening and partnering with community organizations.

As insurance companies, they understand both the health and economic savings that can be achieved if we start investing in prevention and improving health.

It's a good start, but the legacy systems are still working against us. Outdated regulations and billing systems make it harder for insurers to find ways to support programs that are not directly delivered by doctors and licensed medical providers or that help support the health of an entire neighborhood rather than focusing on a specific individual who is tied to a specific billing code.

The Medicaid program has taken a first step in this regard with a proposed rule that would give states greater flexibility in what kinds of prevention programs they can cover. To assure this new flexibility is translated into practice, CMS, the CDC and Medicaid health plans need to work together (along with private insurers) to document and provide information about the best practices, implementation tools and health and cost saving outcomes of community prevention activities -- and provide specific examples supported by Medicaid or by their insurance plan.

As the whole health system is reforming - it's important that coverage for prevention be a top priority if we're ever going achieve a healthier America.

For more healthy living health news, click here.]]>And Many Happy Returns: The Affordable Care Act Turns Threetag:www.huffingtonpost.com,2013:/theblog//3.29164092013-03-20T14:26:01-04:002013-05-20T05:12:02-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
The law, each day, helps move the country from a 'sick care' system to a real health care system. Some of the lesser known but most important provisions of the ACA focus on preventing disease instead of treating people only after they become ill. Millions of Americans are already healthier because of the prevention portions of the law, including Community Transformation Grants (CTG), expanded coverage of preventive services and other measures focused on improving health in the ACA.

The law has also ensured that:

Every new health plan, beginning in 2010, must include coverage of evidence-based, effective preventive services, such as screenings for type 2 diabetes, immunizations and mammograms, without co-pays;

Seniors on Medicare receive many preventive services, starting January 1, 2011,with no co-payments-these services include annual wellness visits, cervical cancer screening, diabetes screening, mammograms and important immunizations such as for the flu and pneumonia; and

The Prevention and Public Health Fund will invest $12.5 billion over 10 years (FY2013-FY2022) in locally-determined, evidence-based community prevention programs and will support public health job creation and training programs. The Fund will provide a coordinated, comprehensive, sustainable and accountable approach to improving the nation's health outcomes through the most effective prevention and public health programs.

One of the law's great prevention successes is the CTGs program -- one of the hallmark initiatives of the Prevention and Public Health Fund. CTGs provide communities with resources to focus on their top health priorities, including smoking cessation and obesity prevention.

In just three short years, the law has been an enormous benefit to Americans. In 2011, the Centers for Disease Control and Prevention (CDC) awarded $103 million in CTGs to 61 state and local public health or related organizations, and, in 2012, CDC funded CTG programs with $226 million, including approximately $70 million in CTG funding to 40 additional communities.

To commemorate the third anniversary of the Affordable Care Act, we at the Trust for America's Health (TFAH) released a story bank featuring stories of successful prevention initiatives in action from around the country. Many of the stories focus on CTG awardees and show how this new program, made possible by the ACA, is already helping to improve the health of Americans. TFAH's Prevention and Public Health Stories in the States story bank includes more than 50 profiles in 28 states, including:

The launch of the first Accountable Care Community (ACC) in Akron, Ohio, which builds on the idea of an Accountable Care Organization. In 2011, the nonprofit organization Austen BioInnovation Institute (ABIA) brought together a wide range of 70 different groups to coordinate health care inside and outside the doctor's office for patients with type 2 diabetes, and received500,000 per year for 5 years for a capacity building CTG. The ACC reduced the average cost per month of care for individuals with type 2 diabetes by more than 10 percent per month over 18 months with an estimated program savings of3,185 per person per year. This initiative has also led to a decrease in diabetes-related emergency department visits.

Oklahoma is using a CTG to work with a range of sectors to make healthier choices easier in the state. Nearly 70 percent of Oklahoma County's premature deaths are largely preventable, and the county spends about920 million every year to treat chronic disease. In September 2011, Oklahoma City was awarded a3.5 million CTG. Using a portion of those funds, along with additional outside resources, the Oklahoma City-County Health Department (OCCHD) created the "My Heart, My Health, My Family" program to provide prevention programs and services, specifically focused on cardiovascular disease. The CTG money will also support expanded walking and biking trails, a push to help schools offer healthy menu options and a physical education coordinator for city schools.

Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) in Kentucky received a capacity-building CTG to help support this program which has delivered important results for a holistic, community-based approach to address substance abuse. UNITE was created a decade ago, however the CTG will help expand its work to support public health efforts aimed at reducing chronic diseases, promoting healthier lifestyles, reducing health disparities and controlling health care spending, and will serve 119 of the state's 120 counties. UNITE works to rid communities of illegal drug use and misuse of prescription drugs by coordinating treatment, providing support to families and friends and educating the public about the dangers of drug abuse.

The West Virginia Department of Health is using CTG support to help local health departments in every county in the state implement targeted initiatives including: safe places in communities to work and play, Farm-to-School Initiatives to improve nutrition in school settings, Child and Day Care Center Nutrition Programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

The ACA began a new era for public health. The law paves the way toward ensuring public health is no longer separated from the rest of the health care system. The ACA supports common-sense community approaches focused on connecting the care people receive in the doctor's office with opportunities to stay healthier beyond the doctor's office, where we all live, learn, work and play.

As the Affordable Care Act continues to benefit the country, in another year, we'll have an abundance of stories to share of communities turning their health around by focusing on preventing illness and thereby creating happy, healthy and thriving neighborhoods.]]>Advancing the Public Health System by Defining the Foundational Capabilities of Public Healthtag:www.huffingtonpost.com,2013:/theblog//3.27582772013-02-25T16:48:39-05:002013-04-27T05:12:01-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
Indeed, they are the chief health strategist in communities.

Unfortunately, public health departments at all levels of government have been chronically underfunded for decades. In fact, according to a 2008 analysis by the New York Academy of Medicine (NYAM), there was a shortfall of $20 billion per year in spending on federal, state and local public health and, in most cases, there is no officially defined mode of coordination for targeting or strategically focusing funding.

To be the chief health strategists for communities, public health departments need the tools and skills required to provide basic public protections while adapting to and effectively addressing changing health threats. The Institute of Medicine (IOM) and the Transforming Public Health project, funded by the Robert Wood Johnson Foundation (RWJF), identified some of these foundational capabilities as developing policy, using integrated data assets, communicating with the public and other audiences to disseminate information, mobilizing the community and forging partnerships, cultivating leadership skills, and demonstrating accountability and protecting the public in the event of an emergency or disaster.

Ensuring these foundational capabilities should become a primary focus of federal, state and local funding, even if it means restructuring some categorical funding streams. Funding must be maintained at a level that ensures these capabilities can be effectively maintained and delivered.

With adequate, stable funding that ensures these basic foundational capabilities, the nation's chief health strategists can take advantage of several evolving opportunities to turn the nation's sick care system into a true health care system.

Opportunity: Changes in the Health System

More than ever before, the health system emphasizes cost containment and improved health. In addition, more people have or will have insurance coverage for direct preventive services under the Affordable Care Act (ACA). The ACA also created the Prevention and Public Health Fund, which includes the Community Transformation Grants (CTG) that help communities invest in proven strategies to improve health.

Public health departments must assume greater accountability for the design and development of the overall strategic plan for improving health in their communities. To do this, health departments must clearly establish their value and role in a reformed health system -- especially in the identification, implementation, coordination and evaluation of cost-beneficial prevention programs and activities.

In addition, public health departments must partner with other sectors (education, transportation, housing and others) and members of the community to make healthier choices easier in every neighborhood and classroom. Public health officials must capitalize on the many opportunities, including CTGs, to promote health and wellness where Americans live, learn, work and play.

The West Virginia Department of Health used CTG support to help local health departments (LHDs) in every county in the state implement targeted initiatives, including: safe places in communities to work and play, farm-to-school initiatives to improve nutrition in school settings, child and daycare center nutrition programs to educate and empower children to choose healthy lifestyles through physical activity and healthy food choices, and community-coordinated care systems that link and build referral networks between the clinical system and community-based lifestyle programs so people can manage their health.

Through the process, West Virginia began transforming the health of the state and has positioned LHDs as the chief health strategist, which will ensure capacity is maintained and programs continue if grant funding disappears.

Opportunity: Budget and Workforce Cuts

As the economy has dipped, massive budget and workforce cuts at all levels of government have forced public health to be nimble and strategic in investments.

The public health workforce should be more versatile and better equipped to handle various public health challenges or threats. The workforce should have policy development skills, management/administrative skills, technological skills and communications skills. To accomplish this, the public health workforce measures in the ACA must be fully funded and implemented; public health curricula and job re-training must include developing skills in Health Information Technology (HIT), policy and legal areas, and cross-sector management; and training programs must emphasize the need for multiple sectors to work.

Currently, some public health departments provide direct services in their communities along with other preventive programs. Since the ACA will expand the number of individuals with coverage and many preventive services are mandated to be covered by many insurance providers, public health departments should reassess their role in the direct provision of medical services (including the option of becoming a federally qualified health center), to ensure they do not use their public health budgets to pay for services that could be billed to insurers or paid for through health center dollars.

Public health departments must also adapt to work with new entities and financing mechanisms in the reformed health system, such as by working with accountable care organizations (ACOs) or within new capitalized care structures and global health budgets.

In FY 2006, Vermont began a five-year "Global Commitment to Health" demonstration agreement (which has been extended until the end of 2013) with the federal government to test the impact of a federal funding cap on Medicaid spending to give the state increased flexibility to manage Medicaid health services. The state pursued this approach to help improve cost containment and expand coverage to the uninsured. Vermont has been receiving monthly payments to cover the needs of all Medicaid beneficiaries. Independent actuaries determined the global budget pool for the state, and if the state was able to control spending under the agreed-upon cap, it could keep the difference, but if it exceeded the agreed-upon cap, the state would absorb the difference. The state was able to keep spending significantly below the agreed-upon amount, and invested some of these excess funds to help improve the health of the population, which in turn helps limit future health care needs, further reducing costs.

Opportunity: New Technologies

For the first time, new technologies -- including electronic health records (EHRs) -- make it possible to revolutionize health tracking by collecting and analyzing health data in real-time and allowing interactive communication among providers, health departments and other sectors

Instead of continuing to have a series of siloed systems to track different diseases and other health problems, connecting different sources of data so they are interoperable and available in real-time could lead to breakthroughs in identifying health trends and patterns. In addition, public health must monitor a range of factors -- from educational attainment to employment -- that impact health outcomes even if they are not under the direct purview of public health.

To take advantage of all these opportunities, the foundational capabilities of public health departments must be defined and supported. As chief health strategists, public health is the essential component of an integrated health system that looks out for the population as a whole, rather than focusing on the health outcomes of individuals alone.

Quite simply, public health is responsible for identifying the biggest, highest cost health problems and developing the most effective strategies for improving health. With adequate resources and appropriate capabilities, public health can lead communities toward comprehensive health care systems that help people get and stay as healthy as they want.

For more healthy living health news, click here.]]>Prevention Does the Body (and America's Wallet) Goodtag:www.huffingtonpost.com,2013:/theblog//3.25901312013-02-01T12:08:31-05:002013-04-03T05:12:01-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/one-half of Americans are currently living with one or more serious chronic disease.

Certainly, some preventive care will only provide the benefits of improved health. However, if the country can be strategic with the investments in prevention, we can improve the bottom line and curb spiraling health care costs.

A 2008 report, "Prevention for a Healthier America," developed by TFAH with the New York Academy of Medicine (NYAM), The Robert Wood Johnson Foundation (RWJF), The California Endowment (TCE), and Prevention Institute, found that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1.

More recently, TFAH released "A Healthier America: Strategies to Move From Sick Care to Health Care in Four Years," which provides high-impact recommendations to prioritize prevention and improve the health of Americans. In the report, the recommendations are paired with examples happening across the country and include preventive initiatives that target health concerns, including asthma, diabetes, prescription drug abuse, childhood obesity, physical (in)activity and workplace wellness.

In addition to the two reports, communities across the country are showing that fighting against spiraling health care costs and for improved health by focusing on prevention benefits everyone. By centering on asthma, diabetes, physical activity and other issues, hospital systems, nonprofits, state and local governments, accountable care communities and insurers are getting a real return on their investment when they focus on prevention.

The ROI of Asthma Prevention

The Community Asthma Initiative (CAI), implemented by Boston Children's Hospital, has provided support to improve the health of children with moderate to severe asthma in at-risk Boston neighborhoods. The CAI has led to a return of $1.46 to insurers/society for every $1 invested, an 80 percent reduction in percentage of patients with one or more asthma-related hospital admission, and a 60 percent reduction in the percentage of patients with asthma-related emergency department visits.

The Green & Healthy Homes Initiative (GHHI) was founded in 2009 to break the link between unhealthy housing and unhealthy children. In 16 cities nationwide, GHHI has achieved a 67 percent reduction in hospitalizations and emergency department visits for children with asthma episodes, saving taxpayer funds supporting Medicaid; accounted for fewer missed school days, improving education attainment and parents' presenteeism; and improved the use of federal dollars.

The ROI of Diabetes Preventive Services

The first-of-its-kind Accountable Care Community (ACC), launched by the Austen BioInnovation Institute in Akron, Ohio, brings together more than 70 partners to coordinate health care inside and outside the doctor's office for patients with Type 2 diabetes. By improving care and making healthier choices easier in people's daily lives, the ACC reduced the average cost per month of care for individuals with Type 2 diabetes by more than 10 percent per month within 18 months of starting the program -- an estimated savings of $3,185 per person per year.

The Diabetes Prevention Program (DPP) is based on the Diabetes Prevention Program Research Study that was led by the National Institute of Health (NIH) and supported by the Centers for Disease Control and Prevention (CDC). The study demonstrated that modest weight loss of 5 percent to 7 percent and increased physical activity to 150 minutes a week through a lifestyle change program reduced the risk of developing Type 2 diabetes by approximately 58 percent. The YMCA of the USA and UnitedHealth Group (UHG) are inaugural partners in the National DPP. In the past two years, the YMCA's DPP (partially funded by CDC and UHG) has trained more than 800 lifestyle coaches, started more than 300 classes in 30 states around the country, and served nearly 6,000 participants, one-third of whom have finished the program. Participants in the Y's program lost an average of 4.8 percent of their body weight, while hundreds of individuals lost an average of 7 percent of body weight.

State and Local Governments and Prevention

In response to increasing premiums due to over-utilization of health care services, poor preventive adherence, and lack of attention towards early detection, in 2009, Nebraska created an Integrated Health Plan. State employees who qualify for the new health plan have lower premium costs and access to comprehensive preventive coverage and year-round wellness programs. In order to qualify, any employee or spouse needs to complete three steps on an annual basis: Participants choose and enroll in their choice of a wellness program (some of which are provided by the state), participants complete a biometric screening option, and participants complete an online health assessment.

Since the integration of Nebraska's new health plan, there have been significant improvements in some high-risk areas. Along with health improvements, the state also saw a reduction of health care costs during the first two years of the program. When comparing wellness program participants' health costs to non-wellness participants, the state saw a reduction of $4.2 million in medical and pharmacy claims. The return on investment for the program in the first two years was $2.70 for every $1 invested in wellness programs.

Insurers and Prevention

Much like many hospitals and hospital systems across the country, insurers are increasingly turning to prevention as a way to improve the quality of life of their patients. In addition, they see prevention as a way to cut their health care costs and improve their employees' health, well-being and productivity.

Blue Cross and Blue Shield (BCBS) companies are using their resources, including hundreds of employee volunteers, to promote wellness and the prevention of disease through programs tailored to meet the needs of rural, urban and targeted ethnic and cultural communities. They have partnered with the first lady's Partnership for a Healthier America to sponsor 40 new Play Streets -- roads closed to traffic and open to the community to encourage physical activity. They also partnered with community organizations to launch Healthy Kids, Healthy Families, focusing on nutrition education, physical activity, managing and preventing disease, and supporting safe environments with the goal of improving the health and wellness of at least 1 million children over three years across its health plans in Illinois, New Mexico, Oklahoma and Texas. In Nebraska, they partnered with community organizations to launch Omaha B-cycle, the first large-scale municipal bike sharing system in Omaha. And, they are working to address health care disparities in low-income and ethnically diverse communities by funding 12 safety net health care center programs in Maryland, Virginia and D.C. that provide health care services for low-income, medically-underserved communities.

Kaiser Permanente funds community health initiatives (CHI) that take a preventive approach to health care through targeted grantmaking and convening and partnering with community organizations. Their CHIs focus on policies and programs that promote healthy eating and active living -- HEAL -- where people live, work and play. Their approach is to assess a community's health, make investments in their needs, and track outcomes, with a minimum of a seven-year to 10-year investment to ensure behavior and health changes.

Strategically and Smartly Investing in Prevention

In "A Healthier America," TFAH argued that moving the nation from a sick care system (wherein we treat people only after they become ill) to a true health care system (that keeps people healthy in the first place) has the potential to keep people healthy and cut costs. The report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective. Some recommendations include:

Advance the nation's public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities.

Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities.

Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs.

Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit.

Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy.

Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

Prevention delivers real value as a cost-effective way to keep Americans healthy and improve their quality of life. Everyone wins when we prevent disease rather than treating people after they get sick. Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.

For more health news, click here.]]>Will We Have a Health Care System or a Sick Care System? A Tale of Two Futurestag:www.huffingtonpost.com,2013:/theblog//3.24274332013-01-19T10:08:57-05:002013-03-21T05:12:01-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
By birth, every American should have the opportunity to be as healthy as he or she can or wants to be. A government that is truly for the people provides everyone with world-class services that protect and support their health. This means access to care, but also access to safe parks and gyms and fresh affordable produce.

For years the United States has approached public health backwards. Indeed, the current health care system has been set up to treat people after they are sick rather than keeping them well in the first place. Our country has a sick care system rather than a health care system.

This is taking -- and will continue to take -- an enormous toll: Health care costs are spiraling out of control, and it is possible that today's children are on track to be the first generation in American history to live shorter, less healthy lives than their parents.

Prevention is the most effective, common-sense way to improve health and reduce health care costs in the United States, but there's never been a strong national interest in prevention. Beginning in 2013, prevention must be a significant focus of the Obama administration's second term and the agenda of the 113th Congress.

There are a couple of high-impact steps that should be taken to put prevention first in our health care system.

1) Advance and modernize the nation's public health system.

This includes establishing a set of core capabilities that all health departments must have and developing a federal public health financing system that guarantees all communities these essential public health services, just as the Affordable Care Act guarantees all individuals certain essential health benefits.

2) Build partnerships within and outside the health field.

Public health departments play a central role as chief health strategists for communities, but they cannot reach goals to improve their community's health on their own. To be effective in improving health in neighborhoods, workplaces and schools, strategies must involve a series of common-sense partnerships, including:

Partnering with health care payers, including both public and private insurers:

More preventive services must be covered by payers, and consumers need to be encouraged to take advantage of them.

Medicaid and private insurance coverage should be expanded to include community-based prevention.

Partnering with health care providers, including expanding health care models to include community prevention and working with nonprofit hospitals to increase engagement in neighborhood prevention strategies:

Fully incorporate prevention into a reforming and evolving health care system, including new delivery mechanisms such as accountable care organizations and Medicaid health homes.

Maximize the community benefit investment of nonprofit hospitals into community-based prevention.

Partnering with sectors beyond the health care system, including drawing the connection between all facets of society (transportation, housing, education, etc.) and health:

Implement the National Prevention Strategy through partnerships across government and with the private sector, faith-based organizations and community groups.

Provide wellness programs and opportunities to all American workers.

These high-impact steps are happening in pockets across the country (from Akron to Baltimore to Billings to Boston to Delaware to Kentucky to King County to La Crosse to Muskegon to Nebraska to North Carolina to Oklahoma to West Virginia). Now it's time to take them to scale.

We need to make the pockets of prevention the norm and ensure that the healthy choice is the easy choice where people live, learn, work and play.

This blog post is part of a series produced by The Huffington Post and the George Washington University that closely examines the most pressing challenges facing President Obama in his second term. To read the companion article by HuffPost's Jeffrey Young, click here. To read the companion blog post by Drew Altman, Ph.D., of the Kaiser Family Foundation, click here. To read all the other posts in the series, click here.]]>HIV Prevention Must Resume Its Place in the Larger LGBT Agendatag:www.huffingtonpost.com,2012:/theblog//3.18626322012-09-10T19:44:00-04:002012-11-10T05:12:01-05:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
Gay men in the U.S. represent the largest proportion of new HIV infections. Young men who have sex with men (MSM) are the only risk group for which HIV incidence appears to be increasing.

Yet these data run counter to the prevailing perception of the epidemic within the gay community -- that is, that things were bad in the 1980s and early 1990s, but once effective treatments came online in the mid 1990s, the crisis passed. How could this be?

First, it is clear that a younger generation of gay men have not been reached with the prevention message. The gay community has been appropriately praised for the tremendous reduction in risky behavior that occurred in the early years of the epidemic. The early mobilization of the LGBT community against HIV, a mobilization that occurred in a hostile political climate and initially with little government support, resulted in an 89-percent decline in the estimated HIV transmission rate.

Second, scientific advances in treating HIV have led the public at large and many in the gay community to consider HIV a treatable, "chronic" disease. And indeed it is -- if people are diagnosed early, and if they have access to quality and sustainable care.

Third, the LGBT community's attention to HIV has declined. By the late 1980s the "professionalization" of the HIV response resulted in waning interest by LGBT organizations in HIV advocacy and mobilization. HIV was left to the growing number of national and local AIDS organizations that took up the cause.

But in mainstreaming HIV as the larger public health challenge that it is, the gay-specific voice has diminished. That's been a missed opportunity to reinforce the self-caring approach that supported so much of the early HIV prevention efforts among gay men. That is not to say that the larger LGBT agenda is not relevant to the fight against HIV. Indeed, it is central: We have solid evidence that higher-risk behavior among gay men is strongly associated with feelings of stigmatization because of sexual orientation and the legacy of family and societal discrimination. So the fights against discrimination, bullying, and hate crimes and for same-sex marriage all validate LGBT people and their relationships and have the potential for bringing a "whole health" approach to HIV prevention among gay men. But these struggles need to be united, not fragmented. And HIV prevention must resume its appropriate place in the larger LGBT agenda.

So what is to be done? Our organizations recently released an issue brief, titled "Ending the HIV Epidemic Among Gay Men in the United States," that outlines a comprehensive agenda that includes taking full advantage of the Affordable Care Act to assure HIV testing, care, and treatment are readily available for all who need them. It also calls for reforms in the health system toward a "whole health" approach to meeting the needs of LGBT people -- from mental health and primary care to HIV prevention interventions for HIV-positive gay men. Among the goals are assuring access to early treatment to decrease a person's HIV viral load, which will improve their health outcomes and reduce the likelihood that HIV will be passed on to others. We also need to scale up HIV testing among gay men and remobilize the LGBT community so that we repeat the successes of the 1980s in changing the course of the epidemic.

This is not a small agenda, and it is one that will require a realigning of resources and priorities inside government and in the community. But the lives of another generation of gay men hang in the balance.

While the focus on gay men is but one element of a national response to HIV (as demonstrated in the comprehensive approach taken by the Obama administration's National HIV/AIDS Strategy), rising HIV incidence among gay men poses the greatest threat to achieving the national goal of creating an AIDS-free generation.]]>The National Prevention Strategy at One: Improving the Health of Individuals, Families and Communitiestag:www.huffingtonpost.com,2012:/theblog//3.15935182012-06-14T13:51:01-04:002012-08-14T05:12:09-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
The National Prevention Strategy (NPS) came at a vital moment, as today's kids could be the first generation in American history to live shorter, less-healthy lives than their parents and more than half of Americans are living with one or more serious, chronic diseases, ranging from Type 2 diabetes to cancer. Those rates are expected to increase significantly over the next two decades, largely due to the obesity epidemic and tobacco use.

Consequently, America faces two futures: If we continue on the same track, we're resigning millions of Americans to major health problems that could have been avoided; or we can invest in giving Americans the opportunity to be healthier while saving billions in health care costs, with the NPS and Prevention and Public Health Fund at the heart of these efforts.

Under the NPS, which was developed by the National Prevention, Health Promotion and Public Health Council, for the first time 17 federal agencies have begun to work together to move the nation from a focus on sickness and disease to prevention and wellness.

In addition, the NPS calls on all sectors -- state, tribal, local and territorial governments; business, industry and other private sector partners; philanthropic organizations; early learning centers, schools, colleges and universities; community and faith-based organizations; and all Americans -- to join with the federal government in a collaborative effort to achieve the strategy's goal to "increase the number of Americans who are healthy at every stage of life."

By committing to including health as a component of policies and programs, these federal agencies are setting an example for all sectors by recognizing how their policies and programs contribute to the nation's health and wellness. In addition, this cross-agency commitment shows how a focus on health and wellness improves their ability to address their core mission -- whether it be education, housing and urban development, transportation, or the many other areas represented on the National Prevention Council.

In conjunction with the anniversary, the National Prevention, Health Promotion and Public Health Council released The National Prevention Council Action Plan: Implementing the National Prevention Strategy, which lays out the framework for implementation of the NPS by the 17 member agencies.

As noted in the action plan, there are many examples of common approaches being taken to improve health across the government's work. For instance, all federal campuses, including the Department of Defense and military bases, are moving toward going smoke-free in the near future. This means millions of additional Americans will be spared from the adverse health effects of secondhand smoke.

In addition, under the healthy eating priority, one of the NPS Federal Actions is to work to ensure that foods purchased, distributed, or served in federal programs and settings meet standards consistent with the Dietary Guidelines for Americans. This action, which includes the Department of Defense, Health and Human Services, Veteran Affairs and the United States Department of Agriculture, will make healthier food choices more readily available to the millions of Americans who are federal employees, while also providing a strong model for the private sector and state and local governments on how they can improve the options they provide to their workforces.

This is an important first step.

I know that my colleagues on the advisory group are committed to assuring that we maintain the momentum of the past year and that real change results from the announcement of this implementation plan. If followed, the strategy will move the country from a sick care system to a true health care system by allowing easy access to resources that can help improve health and wellness for everyone.

For more healthy living health news, click here.]]>Safety First, Yet the Facts Hurt: How Injury Prevention Can Save Livestag:www.huffingtonpost.com,2012:/theblog//3.15454182012-05-25T18:56:06-04:002012-07-25T05:12:18-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/recent report released by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that many injury prevention activities have been scientifically shown to reduce harm and deaths, for instance:

Seat belts saved an estimated 69,000 lives from 2006 to 2010;

Motorcycle helmets saved an estimated 8,000 lives from 2005 to 2009;

Child safety seats saved around 1,800 lives from 2005 to 2009;

The number of children and teens killed in motor vehicle crashes dropped 41 percent from 2000 to 2009; and

School-based programs to prevent violence have cut violent behavior among high school students by 29 percent.

17 states do not require that children ride in a car seat or booster seat to at least the age of 8;

31 states do not require helmets for all motorcycle riders;

34 states and Washington, D.C. do not require mandatory ignition interlocks for convicted drunk drivers;

18 states do not have primary seat belt laws;

44 states scored a "B" or lower on a teen dating violence law review by the Break the Cycle organization; and

14 states do not have strong youth sport concussion safety laws.

In addition, the report identified a set of emerging new injury threats, including a dramatic, fast rise in prescription drug abuse, concussions in school sports, bullying, crashes from texting while driving and an expected increase in the number in falls as the Baby Boomer generation ages.

Injuries -- including those caused by accidents and violence -- are the third-leading cause of death nationally, and they are the leading cause of death for Americans between the ages of 1 and 44. Approximately 50 million Americans are medically treated for injuries each year, and more than 2.8 million are hospitalized. Nearly 12,000 children and teens die from injuries resulting from accidents each year and around 9.2 million are treated in emergency rooms. Every year, injuries generate $406 billion in lifetime costs for medical care and lost productivity.

Our report, which was developed in partnership with leading injury prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Research (SAVIR), concludes that millions of injuries could be prevented each year if more states adopted additional research-based injury prevention policies, and if programs were fully implemented and enforced -- yet lack of national capacity and funding are major barriers to states adopting these and other policies. The report also notes that funding for injury prevention for states from the U.S. Centers for Disease Control and Prevention (CDC) averages only $0.28 per American -- and has dropped 24 percent from fiscal years 2006 to 2011 -- and only 31 states have full-time injury and violence prevention directors, which limits injury prevention efforts.

If we're going to lower the number of injuries in America, we need to redouble efforts. We need to adopt, implement and enforce evidence-based approaches, and increase public awareness of ways we can all keep ourselves and our families safer.

While individuals are responsible for their own safety and protecting themselves and their families from injuries, experts have found that policies and laws, from child safety seats to poison control centers, can help Americans make healthier and safer choices.

The federal government took an important step by including injury prevention as one of the seven priorities in the National Prevention Strategy (NPS): America's Plan for Better Health and Wellness, released in 2011. The NPS brings 17 federal agencies together for the first time to move the nation from a focus on sickness and injury to prevention and wellness. The NPS can help bring new emphasis to the importance of injury prevention and increase momentum to build win-win partnerships between public health and other sectors. For instance, motor vehicle policies and programs involve working with transportation officials, experts and members of industry, while violence reduction efforts can involve community organizations, social services, education, law enforcement, the judicial system and other areas. These collaborations are another key to successfully reducing injuries.

Also, without continued research, we could backslide on the progress we've made in reducing injury in the U.S. We need to invest in more research to continue to improve the policies we already have in place and find innovative solutions to the new threats we face, like the increase in prescription drug abuse and texting while driving.

As our report concludes, right now, the facts do hurt -- but if we adopted, implemented and enforced more evidence-based strategies to prevent injuries, millions of Americans could be spared from injuries each year.

For more healthy living health news, click here.]]>Addressing Disparities, Promoting Health Equity and Ending HIV/AIDStag:www.huffingtonpost.com,2012:/theblog//3.14552742012-04-27T13:54:09-04:002012-06-27T05:12:02-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/as noted by a Trust for America's Health (TFAH) issue brief. In 2009, the estimated rates of new HIV infections among black men and Latino men were 6.5 times and 2.5 times as high, respectively, as that of their white counterparts. Disparities are most severe among young black gay and bisexual men.

The National HIV/AIDS Strategy (NHAS) provides a roadmap for national efforts to end the HIV/AIDS epidemic. The primary goals of the NHAS are to reduce HIV incidence, increase access to care, optimize health outcomes and reduce HIV-related health disparities. The NHAS describes priority areas in need of interventions, outlines steps for a coordinated national response to the HIV epidemic and identifies measurable outcomes. This strategy reinforces the importance of focusing efforts on those at greatest risk, and is paramount in addressing the prevalence of HIV/AIDS among gay and bisexual men, particularly among racial and ethnic minorities.

A critical step in achieving the goals of the National AIDS Strategy is increasing awareness of HIV status (or "serostatus") among gay and bisexual men. Almost 50 percent of HIV transmissions come from the 20 percent of HIV-positive individuals who are unaware of their status. Promoting HIV testing and early linkage to care helps suppress viral load, reinforces less risky behavior, and helps prevent the transmission of HIV.

Increasing knowledge of serostatus requires routine HIV testing in the clinical setting, which can be accomplished through changes to guidelines and reimbursements. This is incredibly important because most individuals who do not know their status have actually had a recent interaction with the health care system but, unfortunately, were not tested. In order to reach the highest-risk populations, including racial and ethnic minorities, there is a need to train providers on testing and creating culturally competent approaches to gay men's health in general.

Representative Maxine Waters recently introduced important legislation that would promote increased HIV testing by removing cost as an obstacle. The Waters bill, Routine HIV Screening Coverage Act of 2012 (HR4470), would require all individual, group and federal employee health insurance plans to reimburse for HIV testing. This bill would be a significant step toward encouraging those who are unaware of their status to get tested.

As noted by the NHAS, HIV testing is just one piece of a comprehensive set of services that are needed to end the HIV epidemic. Expanded knowledge of serostatus must be complemented by a supportive environment for the gay and bisexual community. HIV prevention and treatment efforts, especially for racial and ethnic minorities, can be compromised by stigma and the social determinants of health, including access to stable housing, education, health care, and other key resources. Resources must be provided to mobilize the gay and bisexual community and promote gay men's health at the national, state and local level.

We've come a long way in the battle against HIV/AIDS. However, we must remain vigilant: We cannot ignore the startling statistics of new HIV infections of gay and bisexual men, especially among black and Hispanic men. By pursuing the comprehensive approach to prevention and treatment outlined in the National HIV/AIDS Strategy, we can begin to end the HIV/AIDS epidemic.

Trust for America's Health is proudly taking part in the Health Equity Can't Wait! blog carnival celebrating National Minority Health Month. Participating bloggers are health, consumer, civil rights, and provider advocates committed to promoting health equity. You can find all the posts for the carnival here.

For more on HIV/AIDS, click here.]]>Making the Healthy Choice the Easy Choice: Eliminating Health Disparitiestag:www.huffingtonpost.com,2012:/theblog//3.14453422012-04-23T19:55:32-04:002012-06-23T05:12:02-04:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/responsible for seven out of 10 deaths among Americans each year and account for 75 percent of the nation's health spending. Obesity alone is related to more than 30 illnesses, including type 2 diabetes, heart disease and some forms of cancer.

In fact, black children are four times as likely to die from asthma as non-Hispanic white children, and Hispanics are 1.6 times more likely than non-Hispanic whites to die of diabetes. Health disparities are intricately linked with social inequalities based on a variety of factors, including race and ethnicity, socioeconomic status, sexual orientation and gender identity, gender, age, disability, geography, and religion. In order to improve the health of vulnerable communities, we must create and leverage opportunities to address the social determinants of health and promote health equity.

If we continue on this path, America will never get health care spending under control, the economy will suffer and our children will continue to be at risk of living shorter and less healthy lives than their parents.

Two years ago, the federal government made an historic investment into reversing health disparities and ensuring everyone who wants to be healthy can be. The Affordable Care Act (ACA) provides significant opportunities to improve the health of all Americans, including those in greatest need. The ACA created The National Prevention Strategy (NPS), which prioritizes prevention and wellness and aims to increase the number of Americans who are healthy at every stage of life. The NPS reflects the commitment of the 17 federal cabinet agencies and offices that are part of the National Prevention and Health Promotion Council to addressing health disparities, which is one of the Strategy's four strategic directions. We know that unless the health and non-health contributors to health outcomes are addressed, we will never create health equity in the United States.

In addition to the NPS, the ACA created the Prevention and Public Health Fund (Fund), which provides an unprecedented investment of $12.5 billion over the next ten years in the types of transformative activities proposed in the NPS. The Fund invests in proven, effective programs to prevent diseases and injuries in American communities and that help people make the healthy choice and stay happy and productive. Included in the Fund, the Community Transformation Grant (CTG) program represents a critical opportunity to improve the health of disadvantaged communities.

The CTG program invests in effective community-based interventions. Specifically, the program addresses the leading causes of chronic disease, such as tobacco use, obesity and poor nutrition, as well as health disparities. The CTG program aims to reduce the obesity rate through nutrition and physical activity interventions by five percent over five years. While achieving this goal would have important benefits for all Americans, saving an estimated $30 billion in health care costs according to a recent study, it is likely the gains would be most significant for disadvantaged populations.

Higher obesity rates persist in racial and ethnic minorities, those with less education, and those who make less money. The ACA, NPS, Fund and CTG program present seminal opportunities to improve the health of the most at-risk populations.

All Americans should have the opportunity to lead long, healthy and productive lives. And yet, it is projected that by year 2050, if no action is taken, one in two African-American and Hispanic-Latino children born this generation will develop type 2 diabetes as adults. This statistic is unacceptable because it is preventable. It is necessary to leverage the many opportunities available today in order to promote the future health of all Americans, especially those in greatest need.]]>The Erosion of U.S. Emergency Preparednesstag:www.huffingtonpost.com,2011:/theblog//3.11600392011-12-20T08:11:11-05:002012-02-19T05:12:01-05:00Jeffrey Levihttp://www.huffingtonpost.com/jeffrey-levi/
Unfortunately, the economic crisis has changed the story.

Some of the most elementary capabilities -- including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas -- are experiencing cuts in every state across the country.

This year, "Ready or Not?" has focused on projections into the future: the impact that cuts have had so far, in combination with the proposed upcoming budgets and likely funding scenarios. The analysis found that a number of programs that help detect and respond to bioterrorism and other health emergencies are at risk for major cuts or elimination. These cuts are expected to impact every state in the nation in one way or another. Notably:

51 of the 72 cities that are currently part of the Cities Readiness Initiative are at risk for elimination from the program. This initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies,

All 10 state labs with "Level 1" chemical testing status are at risk for losing top level capabilities, which could leave the U.S. Centers for Disease Control and Prevention (CDC) with the only public health lab in the country with full ability to test for chemical terrorism and accidents;

24 states are at risk for losing the support of Career Epidemiology Field Officers -- CDC experts who supplement state and local gaps to rapidly prevent and respond to outbreaks and disasters, such as during the H1N1 flu pandemic and responding to the health impact of the Gulf Oil Spill in 2010; and

The ability for CDC to mount a comprehensive response to nuclear, radiologic and chemical threats as well as natural disasters is at risk due to potential cuts to the National Center for Environmental Health. All 50 states and Washington, D.C. would lose the support CDC provides during these emergencies.

In the past year, 40 states and Washington, D.C. cut state public health funds -- with 29 of those states and D.C. cutting their budgets for a second year in a row and 15 for three years in a row. In addition, federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation). The Great Recession is clearly taking its toll on emergency health preparedness.

In addition to the above, the report identifies several major vulnerabilities in U.S. preparedness, including:

The ability to maintain basic emergency capabilities -- we often take a knee-jerk band-aid approach to responding to emergencies after they happen instead of being prepared for when they happen;

The lack of a coordinated biosurveillance system, which hampers our ability to detect and track bioterrorism attacks or disease outbreaks;

Gaps in researching, developing and manufacturing vaccines and antiviral medications;

Gaps in the ability to provide care for an influx of patients during mass trauma events; and

Gaps in the way we help communities cope with and recover from emergencies.

Ten years ago, during the anthrax attacks, we saw firsthand what happens when we don't invest in public health preparedness. We were graphically reminded of this again during Hurricane Katrina. The country has made major strides toward being better prepared -- many of the fruits of this investment were evident during the H1N1 flu pandemic response.

While we were still far from our goals, we were leaps and bounds beyond where we were in 2001. Sadly, the track we're on now with the budget cuts may mean history could tragically repeat itself.
When the next disaster strikes, we won't be ready.

The 14 universities at risk to lose Preparedness and Emergency Response Learning Center funds: Columbia University Mailman School of Public Health; Harvard University School of Public Health; Johns Hopkins University Bloomberg School of Public Health; Texas A&M School of Rural Public Health; University of Alabama School of Public Health; University of Albany SUNY School of Public Health; University of Arizona College of Public Health; University of Illinois; University of Iowa College of Public Health; University of Minnesota School of Public Health; University of North Carolina Gillings School of Global Public Health; University of Oklahoma College of Public Health; University of South Florida College of Public Health; University of Washington School of Public Health.

The nine universities at risk to lose Preparedness and Emergency Response Research Center fund: Emory University; Harvard School of Public Health; Johns Hopkins University Bloomberg School of Public Health; University of California at Berkley and Los Angeles; University of Minnesota; University of North Carolina; university of Pittsburgh; University of Washington.
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